the pontiff each and every week. the pope saying today he does not want to be considered a star. thanks for watching al jazeera america. i'm del walters in new york. check us out 24 hours a day on aljazeera.com. >> there are reasons why men and women in uniform are killing themselves. even as military efforts to handle the problem escalate. a tragic, less to war is the "inside story." hello, i'm ray suarez. during america's two wars this

century, one problem has been constant and resistent to efforts to combat it. service people, in theater and stateside, men and women, active duty and reserve, in all branches of the service, have been killing themselves at a high rate. the pentagon is trying to figure out why. head people off before they end their lives, and the suicide rate has remained stubbornly high. a new report on efforts to reduce suicide on this edition of "inside story." and first this background. the largest study of mental health ever conducted on u.s. military personnel revealed a startling fact. nearly half of soldiers who reported a suicide attempt said that their first attempt was prior to enlistment. it was believed that long, repeated deployments in recent wars were the cause, but now the first look at a huge mental

health study abandons that idea and points to a need for better understanding the young people who sign up to fight in the nation's defense. the news comes to an army study in risk in service members. stars. it's funded by the army and the national institutes of mental health. three new star today were released this week in the journal of american medical association's psychiatry article. one-half of troops suffered from some form of mental illness before they entered the military. one in five in panic disorder or adhd and one in ten had intermittent explosive disorder, a tendency for anger and sudden rage. this was five times higher than the average rate in the civilian population. it was seen as the most common

risk factor for suicide at behavior. in the height of the wars in afghanistan and iraq, between 2004 and 2009, the military suicide rit more than doublinged since the pentagon started tracking the number in 2001. 569 soldier's deaths were ruled suicides during that period. 2012 saw a peak in military suicides, 349 service people taking their own lives. >> we also need to keep improving mental health services. >> at an address in the national convention, president obama talked about the need for improving mental health services. >> last year, i said it needed to be an all-hands on deck approach, not just in the va, but across the government. and i issued an executive order to step up our game, and we have. hiring bore councilors and mental health providers, new awareness campaigns, so those

who are hurting know that asking for help is not a sign of weakness. it's part of staying strong. it's a part of getting back up. >> reporter: the suicide rate has fallen. it was down 22% last year. the national institutes of meant al health say that the root causes for army suicide are unknown, but the new star studies point to risk factors which may help to identify factors and help existing programs to help service members at higher risk. >> much that's in the latest report stands to reason, and there's plenty that's counter intuitive. a closer look at suicide and the u.s. military on this edition of the program. joining us are, from tallahassee, charles figly, he's coauthor of families under fire. a handbook for systemic therapy

with military families. amy nyberger miller, from taps, those left behind after military suicides, and in boston, ronald kessler, the principle investigator of the site for army study to assess risk and resilience in service members, and ronald kessler, let me start with you, once all of the numbers were crunched and the results apparent, were you surprised to find that things like deployment didn't have that much of an impact on who decide to end their lives? >> yes. the first surprise of the study was that the increase in the suicide rate was equally high among people who had never deployed as those who had deployed. and prior to that time, we thought as a knee-jerk reaction,

and that's not the case. >> are there defenses, dr. kessler, been male and female personnel. >> well, there are differences in suicide rates among men and women. men have much higher suicide rates than women do. and that's true in civilian life and in the army. but in deployment, the striking difference is, the suicide rate of men who are deployed is roughly 50% higher than the suicide rate of male soldiers never deployed. and among women, it's 300% higher than those deployed than never deployed. it's something that's more highly distressing in the deployment of men and women. the numbers doesn't count for the suicide problem because the portion of women deployed is so small. but nonetheless, it's quite striking. >> charles figly, the numbers

would tell us that a number of these people had problems before they entered the military. and many even had a suicide attempt before they enlisted. and why is that significant, especially given the age of people before they joined? >> first of all, there's a considerable amount of mental disorders among college students. when i was in the marine core, i had been part of some university for a long time. 40 years or so. and there has been an uptick in the number and severity of mental disorders among our students, not just at tulane and florida state, but across the nation. >> does that indicate that there's something different about today's youth in general, and not just those who decide to enlist? >> there are a lot of good things about the youth today. and i could go on and on,

particularly about the tulane students, and they're not much different in the past, but we're doing a better job of analysis and assess many. better at engaging people than ever, and counseling has never been better, and as a result of that, we notice more and we're better at it. >> amy nyberger miller, the army has been trying to get a handle on this for years, during the iraq and afghanistan wars, has the outreach been enough? has there been a good tool kit for the families still in uniform, telling them to look out for things? are you getting them the kind of help and the kind of debriefing you need after that you need? >> well, what we find is there are many people in the military who are allies with us in supporting suicide prevention among the troops. there's a new suicide prevention

office and new evidence-based perhaps, and there's a lot of work going on in the military community among non-profits and the government to try to work on this issue together and to partner together. and we're making headway, but we do still have a aways to go. >> one of the things that's interesting in the report about suicidal thoughts, and what they calling, in technical terms, ideation, and if you're at home and someone expresses an idea of harming themself, is it clear who you call if you're in the serviceman's or service well's family. >> there's a veteran's crisis line, and the website, and there's confidential help there available 24-7, and we encourage families, if they're concerned, to reach out and receive help. there's good help available. and it can work for many people. >> charles figley, when you

hear amy saying this it can work for people, is it tough for the military to put together a set of procedures and guidelines for people in command and at home to know what to look for to prevent it before it happens? >> well, first of all, warriors have come home from war forever, in every culture, and when they come back, they're changed, they're different. and those who love them and care about them can look in their eyes and tell that there's a change, there's a difference, but are they close to suicide or are they going through a process that all veterans from gone through? we just can't tell at this point in time. eventually, we'll have biomarkers, and we can spit into a cup and be able to analyze that, looking at the cortisol levels, et cetera. those days are not here yet, but

we're going in that direction very quickly. my heart goes out to her and to everyone working with veterans close to suicide. because they vicariously experience this terrible loss themselves. but i know that the army is doing all they can to work on this issue. and indeed, the rate has gone down. my hope is that we would study why it has gone down, as well as the reasons it's going up. part of it is the end of the war, which is useful, in terms of causing less distress. this is not a new finding, and i know ron knows this, that in the past, there have been efforts to pin deployment on suicide rates, and it's not the case. because those who are not deployed -- in other words, it's not an issue, but we can't look inside of the minds of those who haven't been deployed yet and know that they're going to be

deployed, especially if they are enlisted. so we can't rule out the shadows on those who took their lives. >> we're going to take a short break right now, and when we come back, we'll talk about the ways that people who join the military are different and the same from those who don't. and how it may have been impact on who tries to end their life and who doesn't. this is "inside story."

>> welcome back to "inside story." i'm ray suarez. on this edition of the program, we're talking about the mental health in the u.s. military. new findings, based on an ongoing collaboration between the army and the national institutes of mental health, show that one in five soldiers had a common mental illness before enlisting, and professor kessler, i'm wondering why that wasn't caught, or why they were

allowed to enlist. does the research through the numbers give us an insight into that? >> well, the kinds of mentality disorders we're talking about are not the ones that the audience may be thinking. if you have schizophrenia or bipolar disorder or if you had a suicide attempt in the past, you're not allowed to enter the military. the kinds of disorders that we found to be common to soldiers which started prior to enlistment and seem to be common in the rest of the population, are attention deficit disorder, which is vo common, and intermittent explosive disorder, which you mentioned, uncontrol abattacks of anger and exploding, and they were not more suicidal prior to entering the army, and they were not more anxious or more depressed. as a matter of fact, in terms of anxiety, you might imagine that

the teenager who is a fearful kid is not going to be the kind of person who joins the army. people who joined the army were more self-confident, more risk takers, competed, adventure seeking, and less anxious than other people. so the kinds of things that were there in abundance, compared to the population, had to do with impulsivity, anger, and some bit of anti-social behavior. >> the rate of impulse of anger, according to the study, was five times higher among soldiers than civilians. is that a marker for predisposition for problems down the road? >> well, it is. and we don't think of anger as being something that's associated with suicide. we more typically think of the common mind with depression. but in fact, people who are angry at other people, who are aggressive, do in fact have increased rates of being angry

and violent toward themselves, higher suicide rates. we know that from people who are perpetrators of violent crime, for example, have higher suicide rates than other people. >> amy nyberger miller, are people sometimes put in the situation of being retrospective, of reporting things only after it's too late along the way? >> well, we support families grieving the death of anyone serving in the armed forces, including those who die by suicide. and we find that often when they reflect and look back, they can identify conversations that could have been different, and seeking what they wanted to encourage, and they often can't identify. and so our families can be a place that helps form researchers and outreach efforts. >> but are there things that

perhaps at the time you don't read that much into, but then after someone takes their own life, you realize they were not themselves or not the person that you knew before they deployed? >> many of our loved ones knew that their family member was in trouble and needed support. and often they were trying to support that person, but they encountered difficulty inning able to do that sometimes. and so far families, it's about how you reconstruct that narrative in your mind and figure out how we can better inform these efforts. some of them, they knew their loved ones were in great pain and struggling and they were fearful and sometimes they don't know how to help their loved one. >> professor figley, there's a whole discipline around this now. i had never seen the word, traumatology until i was reading about your work today. but i also assume that different people handle the terrible stresses of war in different

ways. >> yes, well first of all, i think it's an amazingly important study. and one of the most celebrated at this effort for a long time, including our efforts in katrina in new orleans. and we have to be concerned about recruitment and screening and that's very important. but it's extremely hard to screen for suicide. and obviously we ask the questions, but it's very easy to say no if you really want to come in the military. what makes the difference is creating these predictive factors of training, education, simulation, of developing a spirit of esprit decor. the marine corp, and the army and other branches of service are superb at doing that.

so yes, there are some who come into the military that are wounded. and i think that even ron and his group talked about how to screen for those folks and how to help them out. i think that was in the first paragraph of this discussion, but i guess i don't want anyone to go away from this program thinking, boy, our current military is a mess. they had all of these problems, and then they ended up being in the military. this is the finest fighting force we have ever had ever in our country and in the world, i would say, and we have asked more of these young men and women than we have in any other generation, including world war ii. so it's time for us, yes, to recognize that there are flaws and difficulties, but it's time to step up and to do what we should be doing for these young men and women and their families. even though there has been a lot of money that has gone into this, we're still very very short on that mark. >> what we should do to protect these men and women.

we're going to take a short break, and when we come back, we're going to talk more about the military's response to the challenge of suicide. what has worked, what hasn't, and what we could be doing better. this is "inside story."

>> welcome back to "inside story." i'm ray suarez. the defense department ban tracking suicides in the military back in 2001. 349 service members meted suicide in 2012, which was a record. the number fell to 245 last year. three new studies released this week are heighting the risk factors that contributed to the problem. still with us, charles figley, tulane university, coauthor of families under fire, a handbook for systemic therapy.

ami nyberger miller, for survivors left behind after suicides, and in boston, ronald kessler, the principal investigator of the harvard medical site for study for resilience in service members. and professor kessler that word, resilience, the army has tried to build it into soldiers in a strong way. and if i remember from the survey, those kinds of things didn't work. is that right? >> no, that's not right. the service didn't look at that. but there was a report that was quite critical of the army program for resilience training. and it's in the early days, it's a smart idea to try to develop ways of strengthening people before they're exposed to trauma. but we don't know a great deal about how to prevent the onset

of mental disorder. we're much better at treating disorders after they occur than preventing them before they occur. we're in the fortunate position in an odd way though, because as you noted from the very beginning, ray, the rates of mental disorders are quite high in the army and occur often before the soldier joins the force. so early detection before they get into the army, to deal with the situations and problems that they had where many years to increase resilience before the fact. >> is it fair to assume, professor kessler, that you can never drive the number down to zero, but maybe cases at the margin can be caught? >> absolutely, there's a lot to be done to reduce the suicide rate in the army. we're never going to get to the point of zero, at least not in our lifetime. we can certainly hope, but we can do a great deal of putting a

big dent in the high rate that we have seen in the repeat years. >> ami, what about outreach to families? is it getting better? >> we find that things are improving, and there are a lot of efforts underway, especially educating military families about risk factors to look for and how to get help. >> professor figley, if we had a program in out of the pentagon and all branches of the service, would we be able to really put a dent, a really big dent in this number, or because of the age that young service people mostly are, heavily concentrated in their younger years, are we just going to have to understand that there's going to be a certain amount of suicide as there is in the civilian world? >> yes, ray. thank you. yes, i definitely think that is the case. think about this.

we're always worried about school shootings. have we been that effective in preventing them? what makes a difference in school shooting presence is the same thing in the military and killing themselves. it's connection with human beings. having a buddy, a friend. someone who knows your moods and cares about you. a connection, a bonding. we know quite a bit about that. and the military, just by being the military, does a certain amount of that. but i think we need to do more than that. the marine corp sometime ago started training marines right in boot camp, and they trained marines, but also the chain of command officers, inning able to recognize these stressors and handling it, and giving them tools to manage their own stress. >> professor kesler, the sociologists and the medical

people were very critical of the vietnam military people, shifted out of units, and not sent with their buddies in their hometown, and that was said to have a really bad effect on mental health and unit discipline. is it different now? and when we compare wars to each other, is it very different from those killing themselves now from world war ii, world war i and vietnam. >> yes, the rates are higher now. traditionally, as charles knows, the suicide rate goes down in times of war. the fact that there has been this increase in this particular war is really unprecedented. the ways in which one can attack this problem though, i think have to be thought of as a multitude of relatively small, focused kinds of efforts. not one particular thing. there are a number of these one kind of thing fits all that

happen to be true. the one about deployment that we mentioned, concession waivers, and reducing requirements, and getting less qualified people in, that's not the case, long deployment, and short time between these deployments. if you look at these things, there doesn't seem to be much going on, but when we look closely at in-depth patterns, we see a number of pockets of high-risk, where there are good opportunities for intervention, and our hope in those studies is we're going to increase the number of pockets that we see. and i can give you examples of a few of them. but i think that's our best bet, not trying to look for one quick fix. but this is a multifaceted problem and things have to line up in the way. >> this is something that we'll be talking about in the future. that brings us to the end of

this edition of "inside story." thank you for being with us. in washington, i'm ray suarez. welcome to al jazeera america. i'm del walters. these are the stories we are following for you. diplomatic efforts to stabilize the situation? ukraine. secretary of state john kerry meeting with russian's foreign minister in paris. >> crimea, was, is, and will be an integral part of the state of ukraine. >> ukraine's new prime minister talking about those tensions in crimea. as russian navy ships remain in the port.